全角膜上皮移植术治疗角膜缘干细胞功能障碍

Pan-keratoepithelioplasty for treating limbal stem cell dysfunction

目的探讨全角膜／指环形上皮移植术治疗各种眼表疾病引发的角膜缘干细胞功能障碍的手术技术和成败因素。方法通过13例（14眼）各种眼表疾病引发的角膜缘干细胞功能障碍的全角膜或指环形上皮移植术，系统观察该项眼表重建术的临床规律和影响成败的多种因素。结果术后平均随访8．4月（3～24月），12眼（85．71％）眼表稳定，朱发生上皮缺损；术后视力显著提高，有11眼脱盲（≥0．05），8眼获得能够自主生活的裸眼视力（0．1～0．5）；失败2眼。结论同种异体全角膜或指环形上皮移植术能够有效地为干细胞衰竭眼提供新的眼表上皮来源，使大多数术眼回归正常或接近正常的生理状态，获得有用视力；未能获得良好视力者，也因重新获得稳定的眼表，为尔后的增视性角膜和品状体手术提供了组织解剖学基础。

Objective To investigate the surgical techniques and affected factors associated with success of surgery, Methods A clinical study of pan/annular keratoepithelioplasty （KEP） was performed retrospectively in fourteen cases with limbal stem cell dysfunction. The clinical regularity and ＇affected factors associated with success of surgery were investigated. Results The patients followed up for a mean of 8.4 months （ranged from 3 to 24 months） after surgery, 12 of 14 eyes （85.71%） maintained a stable surface at last exam, and none had epithelial defect. Mean visual acuity improved from ≤ 0.035 to 0. 18; of the 12 eyes, 11 eyes in which the cornea remained clear had a mean visual acuity of 0.05. Eight cases had visual acuity O. 1 to 0.5. Two cases had failure of surgery. Conclusion Allograft of pan/annular keratoepithelioplasty is an effective pathway to supply epithelial cell regeneration resource for patient with limbal stem cell dysfunction. 85.71% of patients after surgery maintained a stable surface at last exam, and 78.57 % of patients （11 of the 14 eyes） acquired useful visual acuity;The others in which the cornea still remained opacity, however in which to perform optical surgeries （penetrating keratoplasty or lenticular surgery） will be possible because the patients acquired a stable ocular surface.